The Illusion of Patient Choice in End-of-Life Decisions

Abstract

Over the past two decades a societal consensus has developed around the principle that decisions about life-sustaining treatment should be guided by patient self-determination. According to the President's Commission, the Hastings Center, the American Medical Association, and the US Supreme Court, treatment decisions should be based on the values, goals, and preferences of the patient. While theory may emphasize the patient's values, empirical data suggest that other considerations may have a greater impact on decisions about life-sustaining treatment. In particular, there is increasing evidence that physician values may be a more decisive factor than patient values in these decisions.